Manizheh Mostafa GHAREHBAGHI, Ali PEIROVIFAR, Mortaza GHOJAZADEH, Majid MAHALLEI

Efficacy of azithromycin for prevention of bronchopulmonary dysplasia (BPD)

Bronchopulmonary dysplasia (BPD) remains one of the most serious and challenging complications in premature infants. This study was conducted to evaluate the efficacy of azithromycin in the prevention of BPD in very low birth weight preterm infants Materials and methods: Preterm neonates with birth weight less than 1500 g were enrolled in a prospective randomized controlled clinical trial. One hundred eight neonates were randomly allocated to the intervention group (n = 56) or control group (n = 52). The intervention group received oral azithromycin 10 mg/kg for 1 week followed by 5 mg/kg for another week. The outcome measures were development of BPD at 28 days of birth and 36 weeks postmenstrual age (PMA). Results: The mean gestational age of the studied patients was 29.2 ± 3.6 weeks and their birth weight was 1173.9 ± 261 g. There was no significant difference in participants’ sex distribution or their gestational age between the 2 groups. Twenty-one (43%) of the 52 patients in the control group met the definition of BPD at 28 days while 14 (25%) did in the azithromycin group (P = 0.04). Twelve patients were oxygen dependent (moderate to severe BPD) at 36 weeks PMA; 9 of them were from the control group (P = 0.04). Conclusion: Our study suggests that azithromycin is effective in reducing the incidence of BPD in very low birth weight infants. More studies are needed with large numbers of patients before recommending routine use of this relatively safe drug for prevention of BPD.

Anahtar Kelimeler:

Key words: Bronchopulmonary dysplasia, very low birth weight infants, prematurity, azithromycin, prevention

Efficacy of azithromycin for prevention of bronchopulmonary dysplasia (BPD)

Keywords:

Key words: Bronchopulmonary dysplasia, very low birth weight infants, prematurity, azithromycin, prevention,

PDF

___

Northway WH, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline membrane disease. bronchopulmonary dysplasia. N Engl J Med 1967; 276: 357- 368.
Merritt TA, Deming DD, Boynton BR. Th e new bronchopulmonary dysplasia: challenges and commentary. Semin Fetal Neonatal Med 2009; 14: 345-357. 3. Jobe AJ. Th e new BPD: an arrest of lung development. Pediatr Res 1999; 46: 641-3. 4. Gupta S, Sinha SK, Donn SM. Ventilatory management and bronchopulmonary dysplasia in preterm infants. Semin Fetal Neonatal Med 2009; 14: 367-373.
Fanaroff AA, Stoll BY, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR et al. NICHD Neonatal Research Network. Trends in neonatal morbidity, mortality for very low birth weight infants. Am J Obstet Gynecol 2007; 196: 147. E1-8. 6. Van Marter LJ, Dammann O, Allred EN, Leviton A, Pagano M, Moore M, Martin C. Developmental Epidemiology Network Investigators. Chorioamninitis, mechanical ventilation and post natal sepsis as modulators of chronic lung disease in preterm infants. J Pediatr 2002; 140: 171-6.
Kramer BW, Kallapur S, Newnham J, Jobe AH. Prenatal infl ammation and lung development. Semin Fetal Neonatal Med 2009; 14: 2-7.
Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163: 1723-29.
Marshall DD, Kotelchuck M, Young TE, Bose CE, Kruyer L, O’Shea TM. Risk factors for chronic lung disease in the surfactant era: a North Carolina population-based study of very low birth weight infants. North Carolina Neonatologists Association. Pediatrics 1999; 104: 1345-50.
Oh W, Poindexter BB, Perritt R, Lemons JA, Bauer CR, Ehrenkranz RA et al. Association between fl uid intake and weight loss during the fi rst ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants. J Pediatr 2005; 147: 786-90.
Colayzy TT, Morris CD, Lapidus J, Sklar RS, Pillers DA. Detection of ureaplasma DNA in endotracheal samples is associated with bronchopulmonary dysplasia aft er adjustment for multiple risk factors. Pediatr Res 2007; 61: 578.
Haunaford K, Todd DA, Jeff ery H, John E, Blyth K, GilbertGL. Role of Ureaplasma urealyticum in lung disease of prematurity. Arch Dis Child Fetal Neonatal Ed 1999; 81: F162-7.
Maxwell NC, Nuttall D, Kotecha S. Does Ureaplasma spp. cause chronic lung disease of prematurity: ask the audience? Early Hum Dev 2009; 85: 291-96.
Waites KB, Katz B, Schelonka RL. Mycoplasmas and ureaplasma as neonatal pathogens. Clin Micro Review 2005; 18: 751-89.
Culic O, Erakvic V, Cepelak I, Barisic K, Brajsa K, Ferencis Z et al. Azithromycin modulates neutrophil function and circulatory infl ammatory mediators in healthy human subjects. Eur J Pharmacol 2002; 450: 277-89.
Ballard JL, Khory JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard score, expanded to include extremely premature infants. J Pediatr 1991; 119: 417-423.
Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163: 1723.
Legssyer R, Huaux F, Lebacq J, Delos M, Marbaix E, Lebecque P et al. Azithromycin reduces spontaneous and induced infl ammation in Delta F508 cystic fi brosis mice. Respir Res 2006; 7: 134.
Gerhardt SG, McDyer JF, Girgis RE, Conte JV, Yang SC, Orens JB. Maintenance azithromycin therapy for bronchiolitis obliterans syndrome: results of a pilot study. Am J Respir Crit Care Med 2003; 168: 121-5.
Ballard HO, Anstead MI, Shook LA. Azithromycin in the extremely low birth weight infants for the prevention of bronchopulmonary dysplasia: a pilot study. Resp Res 2007; 8: 41.
Ballard HO, Shook LA, Bernard P, Anstead MI, Kuhn R, Whitehead V et al. Use of azithromycin for the prevention of bronchopulmonary dysplasia in preterm infants: double-blind, placebo controlled trial. Pediatr Pulmonol 2011; 46: 111-8.
Walsh WF, Stanley S, Lally KP, Stribley RE, Treece DP, McCleskey F et al. Ureaplasma urealyticum demonstrated by open lung biopsy in newborns with chronic lung disease. Pediatr Infec Dis J 1991; 10: 823-27.
Wang EE, Frayha H, Watts J, Hammerberg O, Chemescky MA, Mahony JB et al. Role of Ureaplasma urealyticum in the development of chronic lung disease of prematurity. Pediatr Infec Dis J 1988; 7: 547-551.
Perni SC, Vardhana S, Korneeva I, Tuttle SL, Paraskevas LR, Chasen ST et al. Mycoplasma hominis and Ureaplasma urealyticum in midtrimester amniotic fl uid association with amniotic fl uid cytokine levels and pregnancy outcome. Am J Obstet Gynecol 2004; 191: 1382-6.
Mabnata CG, Pryhuber GS, Weinburg GA, Phelps DL. Erythromycin for the prevention of chronic lung disease in intubated preterm infants at high risk for, or colonized or infected with Ureaplasma urealyticum. Cochrane Database Syst Rev 2003. CD003744.
Kotecha S, Hodge R, Schaber JA, Miralles R, Silverman M, Grant WD. Pulmonary Ureaplasma urealyticum is associated with the development of acute lung infl ammation and chronic lung disease in preterm infants. Pediatr Res 2004; 5: 61-68.